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Ultrasound Quarterly - Current Issue

Ultrasound Quarterly - Current Issue
  1. Literature Reviews
    No abstract available



  2. Additional Magnetic Resonance Imaging–Detected Suspicious Lesions in Known Patients With Breast Cancer: Comparison of Second-Look Digital Tomosynthesis and Ultrasonography
    imagePurpose: The aim of the study was to compare the performances of second-look digital breast tomosynthesis (DBT) and ultrasonography (US) for additional magnetic resonance imaging (MRI)–detected suspicious lesions in patients referred for breast cancer. Methods: Fifty-five patients (52.5 [9.3] years) with breast cancers newly diagnosed at a referring hospital underwent MRI and afterward DBT and US in our institution. The frequency for detecting additional MRI-detected suspicious lesions on DBT and US and performances of DBT and US were compared. Results: Of 37 additional MRI-detected suspicious lesions, 27 were detected on DBT and/or US; 2 were detected on both DBT and US, 1 was detected only on DBT, and 24 were detected only on US. Ultrasonography detected more additional suspicious lesions than DBT (P < 0.0001). Twelve (44.4%) of the 27 lesions were malignant. The sensitivity and negative predictive value of US (100.0% and 100.0%) were significantly higher than those of DBT (16.7% and 83.6%, P < 0.001 and P = 0.001). The specificity of DBT was significantly higher (98.1%) than that of US (78.9%, P = 0.002). Positive predictive values of DBT and US were not significantly different (66.7% vs 52.2%, P = 0.598). The area under the receiver operating characteristic curve of US was significantly higher (0.894) than that of DBT (0.574, P < 0.001). Conclusions: Second-look US showed higher performances than DBT for detecting and characterizing suspicious lesions additionally detected on MRI in patients referred for breast cancer.



  3. Cancer Measurement at Ultrasound: State of the Art
    imageAbstract: Reliable and reproducible tumor measurement is fundamental in the oncologic decision making. In this article, we first highlight the importance of a precise tumor measurement, reviewing the correct modality of measuring tumor lesions at ultrasound. Then we analyze the measurement discrepancies between ultrasound and pathology as well as the discrepancies reported between ultrasound and other imaging modalities. Thereafter, basing on the existent literature and on our experience, we discuss the factors influencing the tumor size measurements at ultrasound. Finally, we illustrate the current strategies to improve the effectiveness of cancer lesions measurement.



  4. Can Ultrasound Imaging Predict the Success of an Experimental Steatofibrosis Model?
    imageAbstract: Our goal was to evaluate the role of ultrasound (US) imaging in an experimental 2-hit steatofibrosis rat model. Nineteen female Sprague-Dawley rats were divided into 2 groups: control group (n = 6) and high-fat diet carbontetrachloride (HFD-CCl4) group (n = 13) that was fed with HFD for 14 weeks. Ultrasound was performed to evaluate liver steatosis. The HFD-CCl4 group rats were divided further into 2 subgroups: HFD rats with liver steatosis [US (+) group; n = 6] and without steatosis [US (−) group; n = 7]. All rats in the subgroups were administered with CCl4. In both US (+) and US (−) subgroups, steatosis score, fibrosis score, triglyceride, and hydroxyproline contents were markedly higher compared with the control group. When compared with the US (−) group, triglyceride and hydroxyproline contents were significantly higher in the US (+) group, whereas steatosis and fibrosis scores were not different. Ultrasound imaging may be useful to assess the success of a 2-hit experimental steatofibrosis model.



  5. Can Ultrasound With Contrast Enhancement Replace Nonenhanced Computed Tomography Scans in Patients With Contraindication to Computed Tomography Contrast Agents?
    imagePurpose: Our purpose is to determine the efficacy of ultrasound (US), with the addition of contrast enhancement (CEUS), in the identification and characterization of abdominal pathology compared with nonenhanced computed tomography (CT) scan (NECT). Methods: This prospective cohort study recruited 197 patients with NECT, the majority with renal failure, to have US, with addition of CEUS, if focal pathology was detected, occurring in 145 patients. Nonenhanced CT scan, US, and CEUS images/video files were presented to 2 blinded readers, in anonymous order. Examination quality and positive observations were recorded. True diagnosis was determined with pathology, follow-up imaging, and clinical notes. Data analysis showed sensitivity of NECT and US in the identification and characterization of pathology and sensitivity of CEUS to characterize abnormalities. Results: Most pathology involved liver (n = 87), kidney (n = 35), and peritoneum (n = 13). Ultrasound alone was superior to NECT in the identification of hepatic and renal pathology, with both performing poorly at characterization. With addition of CEUS, characterization of hepatic and renal pathology reached 100%. Nonenhanced CT is superior to US in identification of peritoneal pathology, especially in large patients. Further solid and hollow organ pathology identified and characterized was of insufficient size to draw conclusions. Conclusions: Nonenhanced CT has limited ability to identify and characterize solid and hollow organ pathology. Ultrasound with the benefit of CEUS is superior to NECT in the characterization of focal liver, kidney, and peritoneal pathology. Contrast-enhanced ultrasound outperforms NECT in evaluation of suspect abdominal pathology in those with renal failure.


  6. Papillary Carcinoma Arising in a Thyroglossal Duct Cyst
    imageNo abstract available



  7. Ultrasound-Guided Needle Biopsy of Neck Lymph Nodes in Patients With Suspected Lung Cancer: Are the Specimens Sufficient for Complete Pathologic Evaluation to Guide Patient Management?
    imageBackground: The purpose of this study is to determine the ability of ultrasound guided needle biopsy of a neck lymph node to provide adequate tissue for complete pathologic evaluation of suspected metastatic lung cancer, including molecular testing for epidermal growth factor receptor gene mutations by pyrosequencing and anaplastic lymphoma kinase gene rearrangement by fluorescence in situ hybridization. Methods: Institutional review board approval was obtained and the requirement for informed consent was waived. All ultrasound guided neck biopsies performed July 1, 2011, to June 30, 2015, were retrospectively reviewed, and all biopsies performed for suspected lung cancer metastatic to supraclavicular and cervical lymph nodes were included. Results: Forty patients with suspected lung cancer underwent ultrasound-guided needle biopsy of an abnormal appearing neck lymph node identified on preprocedure computed tomography or positron emission tomography/computed tomography. Thirty-seven patients were subsequently diagnosed with lung cancer and 3 were diagnosed with lymphoma. A definitive pathologic diagnosis was rendered in 95% of neck node biopsies (38/40; 95% confidence interval, 84%–99%). Of the 36 specimens diagnostic for lung cancer, 16 were considered for further molecular testing and the specimen was adequate for molecular testing in 15 (94%; 73%–100%) cases. Therefore, the neck node biopsy specimens were adequate for complete pathologic workup in 93% (37/40; 81%–98%). No complications related to the biopsies were observed. Conclusions: In patients presenting with suspected lung cancer and suspicious neck lymph nodes, ultrasound-guided needle biopsy frequently provides adequate tissue for complete pathologic evaluation and eliminates the need for more invasive procedures.



  8. Editor’s Introduction: The Brave New World of Ultrasound Contrast
    No abstract available



  9. In-Plane Ultrasound-Guided Knee Injection Through a Lateral Suprapatellar Approach: A Safe Technique
    imagePurpose: This study aims to describe a technique for in-plane ultrasound-guided knee arthrography through a lateral suprapatellar approach, reporting its accuracy and related complications. Methods: A retrospective search was performed for computed tomography and magnetic resonance reports from June 2013 through June 2015. Imaging studies, puncture descriptions, and guided-procedure images were reviewed along with clinical and surgical history. A fellowship-trained musculoskeletal radiologist performed all procedures under sterile technique and ultrasound guidance with the probe in oblique position on the lateral suprapatellar recess after local anesthesia with the patient on dorsal decubitus, hip in neutral rotation, and 30 to 45 degrees of knee flexion. Results: A total of 86 consecutive subjects were evaluated (mean, 55 years). All subjects underwent intra-articular injection of contrast, which was successfully reached in the first attempt in 94.2% of the procedures (81/86), and in the second attempt in 5.8% (5/86) after needle repositioning without a second puncture. There were no postprocedural reports of regional complications at the puncture site, such as significant pain, bleeding, or vascular lesions. Conclusions: Our study demonstrates that in-plane ultrasound-guided injection of the knee in semiflexion approaching the lateral suprapatellar recess is a safe and useful technique to administer intra-articular contrast solution, as an alternative method without radiation exposure.



  10. Ultrasonography for Preoperative Diagnosis of Retroperitoneal Fibrosis
    imageAbstract: This study aimed to assess the application of ultrasonography for preoperative diagnosis of retroperitoneal fibrosis (RPF). A total of 51 patients with clinically suspected RPF underwent transabdominal ultrasonography and ultrasound-guided histopathologic biopsy (tAU-UGHB). Retroperitoneal fibrosis was diagnosed in 35 patients; of these, 31 cases (88.6%) received a diagnosis using tAU-UGHB. The ultrasonographic images mainly showed solid, irregular isoechoic masses, which were present behind the retroperitoneum and surrounded the abdominal aorta, inferior vena cava, and ureters and had clear borders with the encapsulated structures. Compared with other retroperitoneal lesions, RPF lesions were mainly located below the initial level of the renal artery, and their internal flow signals were not rich (P < 0.05). Retroperitoneal fibrosis had characteristic ultrasonographic features, and color Doppler ultrasound-guided biopsy could be positioned accurately, safely, and efficiently; therefore, tAU-UGHB can be used as an effective modality for preoperative diagnosis of RPF.


  11. Ultrasound-Guided Percutaneous Biopsy of the Native Kidney: An Axial Approach Along Brödel Avascular Plane of the Lower Pole
    imagePurpose: This study demonstrates the feasibility and safety of the axial approach for real-time ultrasound-guided percutaneous renal biopsy along Brödel avascular plane. Methods: In this retrospective analysis of 41 percutaneous biopsies performed from June 2014 to June 2015, patients' medical records, pathology results, complication rate, and pain score before and during the procedure were reviewed. Results: The average number of sampled glomeruli was 16.1 ± 7.2 (mean ± SD). There were no major complications. The 2 minor complications, transient macrohematuria and small perirenal hematoma, occurred at a rate of 4.89% but regressed spontaneously in both cases. Conclusions: The axial approach along Brödel avascular plane is a feasible alternative approach for percutaneous biopsy of the native kidney.



  12. Sonographic and Magnetic Resonance Imaging Characteristics of Juvenile Papillomatosis: Three Cases With Different Manifestations
    imageAbstract: Juvenile papillomatosis (JP) is an infrequently seen benign proliferative lesion in women younger than 30 years. Herein, we present different clinical manifestations of histopathologically proven JP of the breast, in addition to magnetic resonance and sonographic imaging features of these cases. Patient 1 exhibited nipple discharge and papillary carcinoma accompanied after the operation. Patient 2 presented with a giant mass with cystic and numerous solid nodular components that filled the entire right breast. Patient 3 exhibited cystic areas in a well-circumscribed hypoechoic solid mass besides ahypoechoic mass with indistinct borders, which was evaluated as multifocal JP.



  13. The Effect of the Amniotic Fluid Index on the Accuracy of Ultrasonographic-Estimated Fetal Weight
    imageBackground: Fetal weight estimation is one of the most important aspects of antenatal care. The effects of amniotic fluid volume on the accuracy of estimated fetal weight (EFW) depend on the amount of fluid, in particular whether it is polyhydramnios or oligohydramnios. Previous studies have reported conflicting results of the effects of amniotic fluid volume on EFW accuracy. Aim: The aim of the study was to evaluate the effects of isolated oligohydramnios cases and polyhydramnios on the accuracy of EFW. Materials and Methods: A retrospective study was conducted at a tertiary center. The study groups consisted of 1069 term isolated oligohydramnios cases, 182 term isolated polyhydramnios cases, and 392 term-matched cases with a normal volume of amniotic fluid. Estimated fetal weight error was determined and expressed in terms of systematic error, calculated from mean percentage error and random error. Results: The systematic error did not differ significantly between polyhydramnios and oligohydramnios cases (−3.60 [8.94%] vs −2.73 [9.7%]). The random error was 8.94% in polyhydramnios cases and 9.7% in oligohydramnios cases. The overestimation rate was 63.6% in polyhydramnios cases and 66.3% in oligohydramnios cases. Conclusions: There were no significant differences in the accuracy of EFW between oligohydramnios and polyhydramnios. However, there was a tendency for overestimation in both types of cases.



  14. A Case of Ruptured Interstitial Ectopic Pregnancy: Ultrasonographic Appearance With Gross Pathology Correlate
    imageNo abstract available



  15. Scrotal Ultrasonic Features of Congenital Bilateral Absence of Vas Deferens
    imageObjective: This article discusses scrotal ultrasonic features of patients with a congenital bilateral absence of the vas deferens (CBAVD). Methods: Thirty-six patients with CBAVD were examined to obtain image characteristics of the bilateral testicle and epididymis by ultrasound. Each patient received a pathological examination of the sperm by percutaneous epididymal biopsy. Results: Scrotal ultrasonic features were as follows: (1) testicular volumes were normal in all the 36 patients; (2) 21% (15/72) of the heads of epididymis, 67% (48/72) of the heads and bodies of epididymis, and 12% (9/72) of the heads, bodies, and tails of epididymis could be shown in the 72 epididymides of the 36 patients; (3) cystic or tubular dilation of the epididymis was obvious in all 72 abnormal epididymides; and (4) bilateral vas deferens could not be found in these patients. Johnsen's grading of sperm in all the 36 patients received a score of 7 or higher (scale of 10, lower numbers denote greater dysfunction). Conclusions: Ultrasonography images of the scrotum revealed characteristics that were commonly present in patients with CBAVD. Therefore, this method is helpful to diagnose CBAVD by identifying the features of epididymis structural abnormalities and cystic or tubular dilation of the epididymis.


  16. Literature Reviews
    No abstract available



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